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Nutritional status is an important determinant of treatment tolerance and long-term outcomes in children with acute lymphoblastic leukaemia (ALL). Both undernutrition and excessive weight gain are associated with complications, including sarcopenic obesity. 1–3 However, there are limited data on weight trajectories and dietetic provision services for this group at Great Ormond Street Hospital (GOSH). Our aim is to describe changes in weight during treatment and monitor dietetic input.Data were collected retrospectively using electronic medical records (EPIC). The inclusion criteria were children aged 1–11 years, diagnosed with ALL, and under the care of GOSH between June 2019 and June 2025. Demographics, treatment phase and regimens, serial weights, and dietetic contacts were collected. Data from 122 children were analysed; 55 (44%) were female, and 95% had B-cell ALL. The mean age at treatment initiation was 4.7 years (SD, 2.3) and 7.2 years at completion (p = 0.02). Weight-for-age and BMI z-scores increased from 0.2 to 0.5 (p=0.05); 0.15 to 0.76 (p<0.001), respectively. No significant difference in weight change was observed between treatment regimens (p = 0.3), although the intermediate- to high-intensity regimen showed the largest gain (0.1 to 0.6, p = 0.1). Weight gain and appetite changes were noted in hospital records for 15% of patients at 2–3 weeks of induction and 36% at day 29. Of 122, 85 (70%) children received at least one dietetic review (median number of contacts 6 IQR: 3,24). The most common reason for dietetic referral was for reduced intake/appetite, 34/122 (28%); <3% were referred for weight loss advice. No correlation was observed between weight-for-age z-score and dietetic contact frequency (r=0.01).This is the first evaluation of dietetic involvement in children with ALL at GOSH. Future studies should incorporate detailed assessments, including body composition, to guide earlier nutritional screening and targeted interventions aimed at optimising treatment outcomes.References Egnell C, Heyman M, Jónsson ÓG, Raja RA, Niinimäki R, Albertsen BK, et al. Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia. Br J Haematol. 2022 Mar 1;196(5):1239–47.Malhotra P, Kapoor G, Jain S, Jain S, Sharma A. Obesity and Sarcopenia in Survivors of Childhood Acute Lymphoblastic Leukemia. Vol. 436, INDIAN PEDIATRICS. 2021.Suzuki D, Kobayashi R, Sano H, Hori D, Kobayashi K. Sarcopenia after induction therapy in childhood acute lymphoblastic leukemia: its clinical significance. Int J Hematol. 2018 Apr 1;107(4):486–9.